给 药给 药(( 二二 ))

中国医科大学护理学院王健

Medications

(two)

FACTORS AFFECTING MEDICATION ACTION

A number of factors other than the drug itself can affect its action. A person may not respond in the same manner to successive doses of a drug. In addition, the identical drug and dosage may affect different clients differently.

1.1.Developmental FactorsDevelopmental Factors··During pregnancy women must be very During pregnancy women must be very careful about taking medications.careful about taking medications.··Infants usually require small dosages Infants usually require small dosages because of their body size and the because of their body size and the immaturity of their organs, especially the immaturity of their organs, especially the liver and kidneys.liver and kidneys.··Older adults have different responses to Older adults have different responses to medications due to physiologic changes medications due to physiologic changes that accompany aging.that accompany aging.

2.2.GenderGender Differences in the way men and Differences in the way men and women respond to drugs are chiefly women respond to drugs are chiefly related to the distribution of body fat related to the distribution of body fat and fluid and hormonal differences.and fluid and hormonal differences.3.Cultural, Ethnic, and Genetic Factors3.Cultural, Ethnic, and Genetic Factors Recent research has indicated Recent research has indicated ethnicity and culture may contribute to ethnicity and culture may contribute to differences in responses to differences in responses to medications.medications.

4.4.DietDiet Nutrients can affect the action of Nutrients can affect the action of a medication.a medication.5.Environment5.Environment The client’s environment can The client’s environment can affect the action of drugs, affect the action of drugs, particularly those used to alter particularly those used to alter behavior and mood.behavior and mood.

6.6.Psychologic FactorsPsychologic Factors A client’s expectations about what A client’s expectations about what a drug can do can affect the response a drug can do can affect the response to the medication.to the medication.7.Illness and disease7.Illness and disease Illness and disease can also affect the Illness and disease can also affect the action of drugs.action of drugs.8.Time of Administration8.Time of Administration The time of administration of oral The time of administration of oral medications affects the relative speed medications affects the relative speed with which they act.with which they act.

ROUTES OF ADMINISTRATIONROUTES OF ADMINISTRATION Pharmaceutical preparations are Pharmaceutical preparations are generally designed for one or two generally designed for one or two specific routes of administration. The specific routes of administration. The route of administration should be route of administration should be indicated when the drug is ordered. indicated when the drug is ordered. When administering a drug, the nurse When administering a drug, the nurse should ensure that the pharmaceutical should ensure that the pharmaceutical preparation is appropriate for the route preparation is appropriate for the route specified.specified.

1.1.OralOral

Oral administration is the most Oral administration is the most

common, least expensive, and most common, least expensive, and most

convenient route for most clients. In convenient route for most clients. In

oral administration, the drug is oral administration, the drug is

swallowed. Because the skin is not swallowed. Because the skin is not

broken as it is for an injection, oral broken as it is for an injection, oral

administration is also a safe method.administration is also a safe method.

The major disadvantages are The major disadvantages are possibly unpleasant taste of the possibly unpleasant taste of the drugs, irritation of the gastric drugs, irritation of the gastric mucosa, irregular absorption from mucosa, irregular absorption from the gastrointestinal tract, slow the gastrointestinal tract, slow absorption, and in some cases, absorption, and in some cases, harm to the client’s teeth.harm to the client’s teeth.

2.2.SublingualSublingual In sublingual administration a In sublingual administration a drug is placed under the tongue, drug is placed under the tongue, where it dissolves (Figure 33-2). In a where it dissolves (Figure 33-2). In a relatively short time, the drug is relatively short time, the drug is largely absorbed into the blood largely absorbed into the blood vessels on the underside of the vessels on the underside of the tongue. The medication should not be tongue. The medication should not be swallowed. Nitroglycerin is one swallowed. Nitroglycerin is one example of a drug commonly given in example of a drug commonly given in this manner.this manner.

3.3.BuccalBuccal Buccal means “pertaining to the Buccal means “pertaining to the cheek.” In buccal administration, a cheek.” In buccal administration, a medication (eg, a tablet) is held in the medication (eg, a tablet) is held in the mouth against the mucous membranes mouth against the mucous membranes of the cheek until the drug dissolves of the cheek until the drug dissolves (Figure 33-3). The drug may act locally (Figure 33-3). The drug may act locally on the mucous membranes of the mouth on the mucous membranes of the mouth or systemically when it is swallowed in or systemically when it is swallowed in the saliva.the saliva.

4.4.ParenteralParenteral Parenteral administration is Parenteral administration is administration other than through administration other than through the alimentary tract; that is, by the alimentary tract; that is, by needle. The following are some of needle. The following are some of the more common routes for the more common routes for parenteral administration:parenteral administration:

·· Subcutaneous (hypodermic)Subcutaneous (hypodermic): into : into the subcutaneous tissue, just below the subcutaneous tissue, just below the skinthe skin·· IntramuscularIntramuscular: into a muscle: into a muscle·· IntradermalIntradermal: under the epidermis : under the epidermis (into the dermis)(into the dermis)·· IntravenousIntravenous: into a vein: into a vein

5.5.TopicalTopical

Topical applications are those Topical applications are those

applied to a circumscribed surface applied to a circumscribed surface

area of the body. They affect only the area of the body. They affect only the

area to which they are applied. area to which they are applied.

Topical applications include the Topical applications include the

following:following:

••Dermatologic preparationsDermatologic preparations: applied to the : applied to the skinskin••Instillations and irrigationsInstillations and irrigations: applied into : applied into body cavities or orifices, such as the body cavities or orifices, such as the urinary bladder, eyes, ears, nose, rectum, urinary bladder, eyes, ears, nose, rectum, or vaginaor vagina••InhalationsInhalations: administered into the : administered into the respiratory tract by a nebulizer or positive respiratory tract by a nebulizer or positive pressure breathing apparatus. Air, pressure breathing apparatus. Air, oxygen, and vapor are generally used to oxygen, and vapor are generally used to carry the drug into the lungs. See Chapter carry the drug into the lungs. See Chapter 47.47.

Essential Parts of a Drug OrderEssential Parts of a Drug Order•Full name of the client•Full name of the client•Date and time the order is written •Date and time the order is written •Name of the drug to be administered•Name of the drug to be administered•Dosage of the drug•Dosage of the drug•Route of administration•Route of administration•Frequency of administration•Frequency of administration•Signature of the person writing the •Signature of the person writing the orderorder

ADMINISTERING ADMINISTERING MEDICATIONS SAFELYMEDICATIONS SAFELY The nurse should always assess The nurse should always assess a client’s health status and obtain a a client’s health status and obtain a medication history prior to giving medication history prior to giving any medication.any medication.

••The medication history includes The medication history includes information about the drugs the client is information about the drugs the client is taking currently or has taken recently.taking currently or has taken recently. •An important part of the history is •An important part of the history is clients’ knowledge of their drug allergies.clients’ knowledge of their drug allergies. •Also included in the history are the •Also included in the history are the client’s normal eating habits.client’s normal eating habits. •Any problems the client may have in •Any problems the client may have in self-administering a medication must self-administering a medication must also be identified.also be identified.

Clinical guidelines for administering Clinical guidelines for administering medications medications1.Nurses who administer medications 1.Nurses who administer medications are responsible for their own actions. are responsible for their own actions. Question any order that you consider Question any order that you consider incorrect.incorrect.2.Be knowledgeable about medications 2.Be knowledgeable about medications you administer.you administer.3.Federal laws govern the uses of 3.Federal laws govern the uses of narcotics and barbiturates. Keep these narcotics and barbiturates. Keep these medications in a locked place.medications in a locked place.

4.4.Use only medications that are in a Use only medications that are in a clearly labeled place.clearly labeled place.5.Do not use liquid medications that 5.Do not use liquid medications that are cloudy or have changed color.are cloudy or have changed color.6.Before administering a medication, 6.Before administering a medication, identify the client correctly using the identify the client correctly using the appropriate means of identification, appropriate means of identification, such as checking the identification such as checking the identification bracelet or asking clients to state bracelet or asking clients to state their name or both.their name or both.

7.7.Do not leave medications at the Do not leave medications at the bedside, with certain exceptions (eg, bedside, with certain exceptions (eg, nitroglycerin, cough syrup). Determine nitroglycerin, cough syrup). Determine agency policy.agency policy.8.If a client vomits after taking an oral 8.If a client vomits after taking an oral medication, report this to the nurse in medication, report this to the nurse in charge or the physician or both.charge or the physician or both.9.Take special precautions when 9.Take special precautions when administering certain medications, for administering certain medications, for example, have another nurse check the example, have another nurse check the dosages of anticoagulant, insulin,and dosages of anticoagulant, insulin,and certain IV preparation.certain IV preparation.

10.10.Most hospital policies require new Most hospital policies require new orders from the physician for the orders from the physician for the client’s postsurgery care.client’s postsurgery care.11.When a medication is omitted for 11.When a medication is omitted for any reason, record the fact together any reason, record the fact together with the reason.with the reason.12.When a medication error is made, 12.When a medication error is made, report it immediately to the nurse in report it immediately to the nurse in charge or the physician or both.charge or the physician or both.

Process of Administering MedicationsProcess of Administering Medications1.Identify the client.1.Identify the client.2.Inform the client.2.Inform the client.3.Administer the drug.3.Administer the drug.4.Provide adjunctive interventions as 4.Provide adjunctive interventions as indicated.indicated.5.Record the drug administered.5.Record the drug administered.6.Evaluate the client’s response to the 6.Evaluate the client’s response to the drug.drug.

Five “Rights” of Drug AdministrationFive “Rights” of Drug Administration

• Right drug• Right drug • Right dose • Right dose • Right time • Right time • Right route • Right route • Right client • Right client

ORAL MEDICATIONSORAL MEDICATIONS1.Organize the supplies.1.Organize the supplies.2.Verify the client’s ability to take 2.Verify the client’s ability to take medication orally.medication orally.3.Verify the order for accuracy.3.Verify the order for accuracy.4.Obtain appropriate medication.4.Obtain appropriate medication.

5.Prepare the medication. 5.Prepare the medication. •tablets or capsules (Figure 33-•tablets or capsules (Figure 33-8,9,10)8,9,10)•liquid medication (Figure 33-•liquid medication (Figure 33-11,12)11,12)

6.6.Administer the medication at Administer the medication at the correct time.the correct time.7.Document each medication 7.Document each medication given.given.8.Dispose of all supplies 8.Dispose of all supplies appropriately.appropriately.9.Evaluate the effects of the 9.Evaluate the effects of the medication.medication.

Thank you !